We supported an established health plan in crafting a successful proposal response to retain access to three existing service areas and gain access to two additional Medicaid regions in a state with a large beneficiary population.
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Amidst changing regulatory, technology, and market dynamics, health plans partner with Avalere to ensure their strategy and operations are aligned to achieve long-term goals.
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AI for Health Plans and the Future of Clinical Data
In a three-part video series, Avalere and partners explore how plans can employ artificial intelligence to optimize clinical data management. In the first video, we discuss the regulatory and market dynamics around clinical data and implications for health plans; the second video explores how plans are operationalizing enterprise clinical data; and the third video details real-world examples of how AI can streamline data management and support plans’ decision making.
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State Copay Accumulator Bans Now Affect At Least 17% of Commercial Lives
State legislators are attempting to reduce patient costs and increase access through policies that block copay accumulators and maximizers.
Impacts to Insurance Markets, 2026 and Beyond
Avalere Health experts discuss how they developed and deployed an analytic model to predict likely enrollment changes to assist clients in understanding the impacts on all lines of business as a result of upcoming federal policy changes.
Health Plans 2030: Responding to OBBBA Medicaid Provisions
The OBBBA brings sweeping Medicaid changes, reshaping eligibility, funding, and access, impacting millions of enrollees, providers, and health plans.
Implications of PBM-Pharmacy Co-ownership Legislation
Avalere Health examines how new federal and state efforts to oversee PBM-pharmacy ownership may affect stakeholders systemwide.
Inside the Latest RADV Regulatory Developments
Avalere Health Advisory experts break down major updates to the CMS Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) audit process, including enhanced technology, workforce expansion, and increased audit volume, and how health plans can prepare.
White Paper: Policy Considerations for Refining MA Star Ratings
This paper presents several proposed changes to the MA Stars Rating program and offers insight into how each proposal would impact federal entities, payers, and members.
Unpacking CMS RADV: The Selection Process and Planning for the Future
Avalere experts discuss the CMS Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) audit process and provide insight on how health plans can proactively plan and prepare for these audits.
Health Plans 2030: Unlocking Value through Data & Technology Advancements
With increasingly sophisticated data and technology available, plans should strategize about how to integrate both across the enterprise to drive higher value.
AI for Health Plans: AI and Clinical Data in Action
In the third and final installment of our AI for health plans video series, Avalere is joined by experts Mia Bolton and Teddy Gedamu from Tenasol to share real-world examples of how artificial intelligence (AI) can streamline data management and improve decision-making in health plans.
AI for Health Plans: Harnessing AI to Optimize Clinical Data
In the second installment of our AI for health plans video series, Avalere is joined by experts Mia Bolton and Teddy Gedamu from Tenasol to discuss how plans are operationalizing enterprise clinical data.
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